when to cancel an ivf cycle?
8 Replies
mairead36 - March 24

I had a follow up to my last question please. In your practice, at what point would you decide to cancel an IVF cycle. My estrogen level dropped 40% overnight from 3.7k to 2.2k, and all of the 15 eggs were abnormal. Based on what I've been reading online, I'm surprised that my doctor didn't just cancel my cycle.


B. Jacobs, M. D. - March 25

The decision to cancel a cycle needs to be made by the physician treating the patient and not an arm chair Monday morning quarterback like me. If you started using a product like Anatagon before your estradiol drop, the fall in estrogen level is to be expected.
Good luck.


mairead36 - March 25

i sat down with my RE yesterday to discuss the failed cycle and what went wrong.

they did my first blood work on day 5 of the stimulants, and the estrogen level was over 800 vs her expectation/the norm for 300. she claims that she left a voicemail on my cell phone telling me to drop back to 2 gonal f, from 3, and to come back in two days for more blood work. i got the voicemail, i still have it, and she never mentioned dropping the stimulants just that i should come back in for an appointment. who is responsible for this mistake? i do think that the lack of communication and over stimulation throughout the process was to blame for my failed cycle.

yesterday she said that she had considered discussing with me that we should cancel the cycle, but she just didnt bother. she's a professional, i'm her patient so i'm paying her and trusting her to do the right thing. at most other clinics in nyc they cancel a cycle if estrogen level drops more than 30%.

i wasn't aware of the danger to me, or to the egg quality, of the overstimulation.

i'm not so upset that the cycle didnt work, but more so that the doctor didnt pay enough attention to my protocol and that i've been charged for a full cycle that probably should have been cancelled. post retrieval i also had a situation where the doctor on call wrote a prescription for the wrong level of medrol so that had to be adjusted three days later.

should i change re, change clinic, complain to the mgmt? how do customer disputes usually get resolved in this industry.


B. Jacobs, M. D. - March 25

If you were given Antagon, or some similar product, I would expect the estrogen level to drop. If you did not start a GNRH antagonist, like Antagon, your estrogen drop would certainly indicate a problem.
Good luck.


mairead36 - March 26

I wasn't given antogen or other drug, i was just told to reduce the stimulants i was taking. Does overstimulation always negatively impact the quality of the eggs?


B. Jacobs, M. D. - March 26

Over stimulation can effect the quality of eggs, but more importantly, it can produce a hyperstimulation syndrome. A severe hyperstimulation syndrome is life threatening.


urban - March 29

My husband a vasectomy 10 years ago. He had it reversed 1.5 years ago. His sperm test results were poor. He had a tese and sperm was collected/frozen. I began meds for ICSI. I am 36. I had 9 folicles. 4 mature. Two were fertalized. Overnight 1 arrested. 1 (grade b)was transfered. I was told on Friday, March 27 the transfer was negative.

I am sitting here in shock that I this is my reality. It is 3 in the morning. I can't sleep, can't eat and tears start to run down my face at any given moment through out the day.

Seems like such a long shot with 1 grade b embryo. Should my transfer occured? I have the feeling the clinic was just wanting there payment. Is this a fair thought?

I am awaiting my next appointment. I know the next question for my husband and is...there any point in doing another round? Or should we resort to donor sperm. I feel I am getting a little bit older and my chance are running out (as well as our money). This round cost approx $13,000 CDN.

Like most folks in this situation, I really want a positive result.

I guess I am confused (and terribly upset). I have read so many times, that TESE is almost always successful. Tonight I read a blog that said to someone with a similiar situation her chances are 5-10 percent. My Doctor said 50% overall.

Any advice to a truly devistated person?


urban - March 29

sorry= please ignore my previous post (from urban). I am new the blog and posted a reply instead of a new comment.


B. Jacobs, M. D. - March 29

Without administration of a product like Antagon, I expect to see a progressive rise of estrogen during stimulation. If I see a significant decrease in estrogen, I am concerned that the cycle will not be productive and discuss cancellation with my patient.



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